[p. 1]
ADULT CORE
Section I -- IDENTIFICATION
(2) Not Available
(3) Physical or Mental condition prohibits responding
(7) Refused
(9) Don't know
(1) Yes
(2) No
AIDVERF2 Age = {3 digit format} Is it correct?
AIDVERF3 Birthday = {spoken word format} Is it correct?
Check Item AIDCCI2: If AIDVERF_S = (2) go to AID.040; If AIDVERF_A = (2) go to AID.050; If AIDVERF_D = (2) go to AID.060; Else go to ACN.010. If no changes or when changes complete, go to next section -- Conditions
Is {sample adult name} Male or Female?
(2) Female
(7) Refused
(9) Don't know
(Go to Check Item AIDCCI2)
[Update revised sex AIDSEX in SEX]
(997) Refused
(999) Don't know
(Go to Check Item AIDCCI2)
[Update revised age AIDAGE in AGE]
[p. 2]
(01) January
(02) February
(03) March
(04) April
(05) May
(06) June
(07) July
(08) August
(09) September
(10) October
(11) November
(12) December
(97) Refused
(99) Don't Know
(01-31) 1-31
(97) Refused
(99) Don't Know
(0000-1999) 0-1999
(9997) Refused
(9999) Don't Know
(Go to Check Item AIDCCI2)
[Update revised birthdate in DOB_M, DOB_BDAY, and DOB_Y_P]
[Note: Variables in the AID section are used to verify information collected from the family respondent. They do no exist as separate variables in the analytic file.]
(Go to next section -- Conditions)
[p. 3]
Section II -- CONDITIONS
Have you EVER been told by a doctor or other health professional that you had...Hypertension, also called high blood pressure?
(2) No (ACN.031)
(7) Refused (ACN.031)
(9) Don't know (ACN.031)
(2) No
(7) Refused
(9) Don't know
(2) No
(7) Refused
(9) Don't know
Have you EVER been told by a doctor or other health professional that you had...
(2) No
(7) Refused
(9) Don't know
ANGEV... Angina, also called angina pectoris?
MIEV... A heart attack (also called myocardial infarction)?
HRTEV... Any kind of heart condition or heart disease (other than the ones I just asked about)?
STREV... A stroke?
EPHEV... Emphysema?
ACN.031.010
(2) No
(7) Refused
(9) Don't know
ANGYR... Angina, also called angina pectoris?
MIYR... A heart attack (also called myocardial infarction)?
HRTYR... Any kind of heart condition or heart disease (other than the ones I just asked about)?
STRYR... A stroke?
EPHYR... Emphysema?
[p. 4]
(2) No
(7) Refused
(9) Don't know
PCIRCEV ...Poor circulation in your legs
IRRHBEV ...Irregular heartbeats
CONHFEV ...Congestive heart failure
ACN.031.030
(2) No
(7) Refused
(9) Don't know
PCIRCYR ...Poor circulation in your legs
IRRHBYR ...Irregular heartbeats
CONHFYR ...Congestive heart failure
Have you EVER been told by a doctor or other health professional that you had asthma?
(2) No (ACN.110)
(7) Refused (ACN.110)
(9) Don't know (ACN.110)
(2) No
(7) Refused
(9) Don't know
(2) No
(7) Refused
(9) Don't know
ACN.100
Check item ACNCCI6:If AASMYR=2,R,D, goto AASMED; else go to AASMERYR
(2) No
(7) Refused
(9) Don't know
[p. 5]
FR READ IF NECESSARY: FOR HOMEMAKERS THIS INCLUDES WORK AROUND THE HOUSE.
FR: ENTER 996 IF RESPONDENT UNABLE TO DO THIS ACTIVITY
(001-365)1-365
(996) Unable to do this activity
(997) Refused
(999) Don't know
@A Days
[if @A ge (100) and @A ne (996)] display
{AWZMSWK@A} is an unusually large number.
Did you miss {AWZMSWK@A} days of work due to asthma?]
(1) Correct, proceed to next question
(2) Incorrect, change answer
(2) No
(7) Refused
(9) Don't know
Has a doctor or other health professional EVER given you an asthma management plan?
FR: READ IF NECESSARY: INCLUDE NURSES AND ASTHMA EDUCATORS
(2) No
(7) Refused
(9) Don't know
(2) No
(3) Was told no changes needed
(7) Refused
(9) Don't know
[p. 6]
Have you EVER been told by a doctor or other health professional that you had .......An ulcer? This could be a stomach, duodenal or peptic ulcer.
(2) No (ACN.125.010)
(7) Refused (ACN.125.010)
(9) Don't know (ACN.125.010)
(2) No
(7) Refused
(9) Don't know
(2) No (ACN.125.030)
(7) Refused (ACN.125.030)
(9) Don't know (ACN.125.030)
(2) No
(7) Refused
(9) Don't Know
(2) No
(7) Refused
(9) Don't know
URINPEV ...urinary problems such as incontinence, frequent or slow urination or infections?
ALLRFEV ...an allergic reaction to food or odors?
ALLRMEV ...an allergic reaction to medication severe enough to require treatment or medication?
ACN.125.040
(2) No
(7) Refused
(9) Don't know
URINPYR ...urinary problems such as incontinence, frequent or slow urination or infections?
ALLRFYR ...an allergic reaction to food or odors?
ALLRMYR ...an allergic reaction to medication severe enough to require treatment or medication?
[p. 7]
(2) No
(7) Refused
(9) Don't know
PARKEV ... Parkinson's disease?
NEUROPEV ... Neuropathy?
SEIZEV ... Seizures?
(2) No
(7) Refused
(9) Don't know
FATIGYR ... regularly had excessive sleepiness during the day?
PAINYR ... had recurring pain?
(2) No
(7) Refused
(9) Don't know
(2) No
(7) Refused
(9) Don't know
DENTLPYR ...dental pain?
SKINPYR ...skin problems?
Have you EVER been told by a doctor or other health professional that you had...
Cancer or a malignancy of any kind?
(2) No (ACN.160)
(7) Refused (ACN.160)
(9) Don't know (ACN.160)
[p. 8]
FR: MARK UP TO 3 KINDS. IF RESPONDENT OFFERS MORE THAN 3, CODE "96" IN THE FOURTH BOX. ENTER (N) FOR NO MORE.
(2) Blood
(3) Bone
(4) Brain
(5) Breast
(6) Cervix
(7) Colon
(8) Esophagus
(9) Gallbladder
(10) Kidney
(11) Larynx-windpipe
(12) Leukemia
(13) Liver
(14) Lung
(15) Lymphoma
(16) Melanoma
(17) Mouth/tongue/lip
(18) Ovary
(19) Pancreas
(20) Prostate
(21) Rectum
(22) Skin (non-melanoma)
(23) Skin (Don't know what kind)
(24) Soft Tissue (muscle or fat)
(25) Stomach
(26) Testis
(27) Throat - pharynx
(28) Thyroid
(29) Uterus
(30) Other
(96) More than 3 kinds
(97) Refused
(99) Don't know
[ ]
[ ]
[ ]
[ ]
(001-100) 1-100 years
(997) Refused
(999) Don't Know
CANAGE2 ...CANKIND2 cancer
CANAGE3 ...CANKIND3 cancer
Have you EVER been told by a doctor or health professional that you have diabetes or sugar diabetes?
(2) No (ACN.201)
(3) Borderline (ACN.201)
(7) Refused (ACN.201)
(9) Don't know (ACN.201)
(997) Refused
(999) Don't know
(2) No
(7) Refused
(9) Don't know
[p. 9]
(2) No
(7) Refused
(9) Don't know
(2) No
(7) Refused
(9) Don't know
SINYR ... Sinusitis?
CBRCHYR ... Chronic bronchitis?
KIDWKYR ... Weak or failing kidneys? - Do not include kidney stones, bladder infections or incontinence.
LIVYR ... Any kind of liver condition?
(1) Yes
(2) No(ACN.290)
(7) Refused (ACN.290)
(9) Don't know (ACN.290)
MARK ALL THAT APPLY. ENTER "N" FOR NO MORE
Which joints are affected?
[Card A3 depicts a human form]
Card A3
You may choose more than one
Front
Shoulders
(2) Left
Elbows
(4) Left
Hips
(6) Left
Wrists
(8) Left
Knees
(10) Left
Ankles
(12) Left
Toes
(14) Left
Shoulders
(2) Left
Fingers, Thumb
(16) Left
Knees
(10) Left
( ) = joint
(2) Shoulder-left
(3) Elbow-right
(4) Elbow-left
(5) Hip-right
(6) Hip-left
(7) Wrist-right
(8) Wrist-left
(9) Knee-right
(10) Knee-left
(11) Ankle-right
(12) Ankle-left
(13) Toes-right
(14) Toes-left
(15) Fingers/thumb -right
(16) Fingers/thumb -left
(17) Other joint not listed
(97) Refused
(99) Don't know
DURING THE PAST 30 DAYS, how bad was your joint pain ON AVERAGE?
Please answer on a scale of 0 to10 where 0 is no pain or aching and 10 is pain or aching as bad as it can be.
(97) Refused
(99) Don't know
(2) No
(7) Refused
(9) Don't know
[p. 10]
(2) No
(7) Refused
(9) Don't know
(2) No
(7) Refused
(9) Don't know
ACN.290.010
(2) No
(7) Refused
(9) Don't know
(2) No
(7) Refused
(9) Don't know
(2) No
(7) Refused
(9) Don't know
(2) No
(7) Refused
(9) Don't know
Do arthritis or joint symptoms now affect whether you work, the type of work you do, or the amount of work you do?
(2) No
(7) Refused
(9) Don't know
[p. 11]
Please refer to pain that LASTED A WHOLE DAY OR MORE. Do not report aches and pains that are fleeting or minor.
During the PAST THREE MONTHS, did you have.... Neck pain?
(2) No
(7) Refused
(9) Don't know
During the PAST THREE MONTHS, did you have...Low back pain?
(2) No (ACN.331)
(7) Refused (ACN.331)
(9) Don't know (ACN.331)
ACN.320
(2) No
(7) Refused
(9) Don't know
ACN.331
(1) Yes
(2) No
(7) Refused
(9) Don't know
AMIGR ... Severe headache or migraine?
ACN.350
These next questions are about your recent health during the TWO WEEKS outlined on that calendar.
(2) No
(7) Refused
(9) Don't know
(2) No
(7) Refused
(9) Don't know
ACN.370
(2) No
(7) Refused
(9) Don't know
ACN.370.010
(2) No
(7) Refused
(9) Don't know
ACN.370.020
(2) No
(7) Refused
(9) Don't know
ACN.370.030
(2) No
(7) Refused
(9) Don't know
ACN.370.040
(2) No
(7) Refused
(9) Don't know
Have you ever worn a hearing aid?
(2) No(ACN.420)
(7) Refused (ACN.420)
(9) Don't know (ACN.420)
[p. 13]
Would you say always, most of the time, some of the time, or none of the time?
(2) Most of the time
(3) Some of the time
(4) None of the time
(7) Refused
(9) Don't know
(2) Little trouble
(3) Lot of trouble
(4) Deaf
(7) Refused (ACN.430)
(9) Don't know (ACN.430)
(2) 0 through 2 years of age
(3) 3 through 5 years of age
(4) 6 through 18 years of age
(5) 19 through 44 years of age
(6) 45 through 64 years of age
(7) 65 or more years of age
(97) Refused
(99) Don't know
(2) At birth for genetic reason
(3) Present at birth for some other reason, not including infectious disease
(4) An infectious disease such as measles or meningitis
(5) An ear infection/multiple ear infections
(6) An ear injury
(7) Ear surgery
(8) Loud, brief noise from gunfire, blasts, or explosions
(9) Other noise from machinery, aircraft, power tools, loud music, appliances, Walkman personal stereos, hair dryers, etc.
(10) Getting older
(11) Some other cause? (ACN.420.030)
(97) Refused
(99) Don't Know
ACN.420.030
[p. 14]
(2) No (ACN.440.010)
(7) Refused (ACN.440.010)
(9) Don't know (ACN.440.010)
(2) No
(7) Refused
(9) Don't know
(2) No
(7) Refused
(9) Don't know
CATAREV ...Cataracts?
GLAUCEV ...Glaucoma?
MACDEV ...Macular degeneration?
ACN.440.020
(2) No
(7) Refused
(9) Don't know
CATARYR ...Cataracts?
GLAUCYR ...Glaucoma?
MACDYR ...Macular degeneration
(2) No
(7) Refused
(9) Don't know
(2) No
(7) Refused
(9) Don't know
FR: SHOW FLASHCARD A4.
1. Only a little difficult
2. Somewhat difficult
3. Very difficult
4. Can't do at all
6. Do not do this activity
(1) Only a little difficult
(2) Somewhat difficult
(3) Very difficult
(4) Can't do at all
(6) Do not do this activity
(7) Refused
(9) Don't know
AVDFCLS ...To do work or hobbies that require you to see well up close such as cooking, sewing, fixing things around the house, or using hand tools?
AVDFNIT ...To go down steps, stairs or curbs in dim light or at night?
AVDFDRV ...To drive during daytime in familiar places?
AVDFPER ...To notice objects off to the side while you are walking along?
AVDFCRD ...To find something on a crowded shelf?
ACN.440.060
FR: READ IF NECESSARY: THIS DOES NOT INCLUDE WORK AROUND THE HOUSE.
(2) No
(7) Refused
(9) Don't know
This would have made you temporarily sensitive to bright light.
(2) 1 to 12 months
(3) 13 to 24 months
(4) More than 2 years
(5) Never
(7) Refused
(9) Don't know
This includes activities such as baseball, basketball, mowing the lawn, woodworking, or working with chemicals.
(2) No (ACN.451)
(7) Refused (ACN.451)
(9) Don't know (ACN.451)
CATARYR ...Cataracts?
GLAUCYR ...Glaucoma?
MACDYR ...Macular degeneration
Check Item ACNCCI17: If AVISION=1 or DIBRYR=1 or CATARYR=1 or GLAUCYR=1 or MACDYR=1 then goto AVISREH; else goto ACNCCI18]
(2) Most of the time
(3) Some of the time
(4) None of the time
(7) Refused
(9) Don't know
(2) No
(7) Refused
(9) Don't know
Now I am going to ask you some questions about feelings you may have experienced over the PAST 30 DAYS.
During the PAST 30 DAYS, how often did you feel...
2. Most of the time
3. Some of the time
4. A little of the time
5. None of the time
(2) MOST of the time
(3) SOME of the time
(4) A LITTLE of the time
(5) NONE of the time
(7) Refused
(9) Don't know
NERVOUS ... Nervous?
RES TLESS ... Restless or fidgety?
HOPELESS ... Hopeless?
EFFORT ... That everything was an effort?
WORTHLS ... Worthless?
ACN.530
(2) Some
(3) A little
(4) Not at all
(7) Refused
(9) Don't know
[p. 17]
Section III -- HEALTH STATUS AND LIMITATION OF ACTIVITIES
AHS.030
Part A -- Health Indicators
If DOINGLW1 eq (3,5) and if EVERWRK ne (2,R,D) goto AHS.030;
If DOINGLW1 eq (R,D) or EVERWRK eq (2,R,D) goto AHS.050
(2) No (AHS.050)
(7) Refused (AHS.050)
(9) Don't know (AHS.050)
(1-366) 1-366 Days
(997) Refused
(999) Don't know
(1-366) 1-366 Days
(997) Refused
(999) Don't know
(2) Worse
(3) About the same
(7) Refused
(9) Don't know
[p. 18]
Part B -- Limitation of Activities
(2) No
(7) Refused
(9) Don't know
AHS.091 AHS.141 AHS.171
By yourself, and without using any special equipment, how difficult is it for you to...
(0) NOT AT ALL DIFFICULT
(1) ONLY A LITTLE DIFFICULT
(2) SOMEWHAT DIFFICULT
(3) VERY DIFFICULT
(4) CAN'T DO AT ALL
(6) DO NOT DO THIS ACTIVITY
(7) Refused
(9) Don't Know
1. Only a little difficult
2. Somewhat difficult
3. Very difficult
4. Can't do at all
6. Do not do this activity
FLCLIMB ... Walk up 10 steps without resting?
FLSTAND ... Stand or be on your feet for about 2 hours?
FLSIT ... Sit for about 2 hours?
FLSTOOP ... Stoop, bend, or kneel?
FLREACH ... Reach up over your head?
FR: READ LEAD-IN IF NECESSARY:
By yourself, and without using any special equipment, how difficult is it for you to...
(0) NOT AT ALL DIFFICULT
(1) ONLY A LITTLE DIFFICULT
(2) SOMEWHAT DIFFICULT
(3) VERY DIFFICULT
(4) CAN'T DO AT ALL
(6) DO NOT DO THIS ACTIVITY
(7) Refused
(9) Don't Know
1. Only a little difficult
2. Somewhat difficult
3. Very difficult
4. Can't do at all
6. Do not do this activity
FLCARRY ... Lift or carry something as heavy as 10 pounds such as a full bag of groceries?
FLPUSH ... Push or pull large objects like a living room chair?
FR: READ LEAD-IN IF NECESSARY:
By yourself, and without using any special equipment, how difficult is it for you to...
(0) NOT AT ALL DIFFICULT
(1) ONLY A LITTLE DIFFICULT
(2) SOMEWHAT DIFFICULT
(3) VERY DIFFICULT
(4) CAN'T DO AT ALL
(6) DO NOT DO THIS ACTIVITY
(7) Refused
(9) Don't Know
1. Only a little difficult
2. Somewhat difficult
3. Very difficult
4. Can't do at all
6. Do not do this activity
FLSOCL ...Participate in social activities such as visiting friends, attending clubs and meetings, going to parties?
FLRELAX ...Do things to relax at home or for leisure (reading, watching TV, sewing, listening to music)?
[p. 20]
What condition or health problem causes you to have difficulty with {names of up to 3 specified activities/these activities}?
[Else]
What condition or health problem causes you to have difficulty with these activities?
FR: SHOW FLASHCARD A6. MARK ALL THAT APPLY, BUT DO NOT PROBE. ENTER (M) FOR CONDITIONS NOT ON THE FLASHCARD. ENTER (N) FOR NO MORE.
You may choose more than one
2. Hearing problem
3. Arthritis/rheumatism
4. Back or neck problem
5. Fracture, bone/joint injury
6. Other injury
7. Heart problem
8. Stroke problem
9. Hypertension/high blood pressure
10. Diabetes
11. Lung/breathing problem
12. Cancer
13. Birth defect
14. Mental retardation
15. Other developmental problem (e.g., cerebral palsy)
16. Senility
17. Depression/anxiety/emotional problem
18. Weight problem
Other impairment/problem
AFLHCA2 (2) Hearing problem
AFLHCA3 (3) Arthritis/rheumatism
AFLHCA4 (4) Back or neck problem
AFLHCA5 (5) Fractures, bone/joint injury
AFLHCA6 (6) Other injury
AFLHCA7 (7) Heart problem
AFLHCA8 (8) Stroke problem
AFLHCA9 (9) Hypertension/high blood pressure
AFLHCA10 (10) Diabetes
AFLHCA11 (11) Lung/breathing problem (e.g. asthma and emphysema)
AFLHCA12 (12) Cancer
AFLHCA13 (13) Birth defect
AFLHCA14 (14) Mental retardation
AFLHCA15 (15) Other developmental problem (e.g. cerebral palsy)
AFLHCA16 (16) Senility
AFLHCA17 (17) Depression/anxiety/emotional problem
AFLHCA18 (18) Weight problem
(99) Don't know
(M) More conditions (AHS.200)
AHS.200
(20) Kidney, bladder or renal problems
(21) circulation problems (including blood clots)
(22) Benign tumors, cysts
(23) Fibromyalgia, lupus
(24) Osteoporosis, tendonitis
(25) Epilepsy, seizures
(26) Multiple Sclerosis (MS), Muscular Dystrophy (MD)
(27) Polio (myelitis), paralysis, Para/quadriplegia
(28) Parkinson=s disease, other tremors
(29) Other nerve damage, including carpal tunnel syndrome
(30) Hernia
(31) Ulcer
(32) Varicose veins, hemorrhoids
(33) Thyroid problems, Graves=disease, gout
(34) Knee problems [(not arthritis (03), not joint injury (05)]
(35) Migraine headaches (not just headaches)
(36) Other impairment/problem (specify one)
(37) Other impairment/problem (specify one)
(97) Refused
(99) Don't know
If answers = 1-37 then go to AHS.300; Else go to end of section.
FR: SPECIFY CONDITION CAUSING LIMITATION. THIS SHOULD BE THE NAME OF A SPECIFIC CONDITION THAT IS NOT ON THE CONDITION LIST.
(01-94) 1-94(97) Refused
(95) 95+(99) Don't know
(96) Since birth
(1) Days(6) Since birth
(2) Weeks(7) Refused
(3) Months(9) Don't know
(4) Years
[AHS.300 - AHS.336 are asked for each condition reported in AHS.200]
Section IV - HEALTH BEHAVIORS
Part A - Tobacco
AHB.010
(2) No (AHB.090)
(7) Refused (AHB.090)
(9) Don't know (AHB.090)
FR: IF LESS THAN 6 YEARS OLD, ENTER "6"
(95) 95 years or older
(96) Never smoked regularly
(97) Refused
(99) Don't know
(2) Some days (AHB.060)
(3) Not at all (AHB.040)
(7) Refused (AHB.060)
(9) Don't know (AHB.060)
(01-94) 1-94
(95) 95+
(97) Refused (AHB.090)
(99) Don't know (AHB.045)
(1) Days
(2) Weeks
(3) Months
(4) Years
(7) Refused
(9) Don't know
(2) No
(7) Refused
(9) Don't know
(Go to AHB.090)
[p. 23]
FR: IF LESS THANA1", ENTERA1"
(95) 95+ cigarettes
(97) Refused
(99) Don't know
(Go to AHB.080)
(1-30) 1-30 Days (AHB.070)
(99) Don't know (AHB.070)
(97) Refused (AHB.070)
FR: IF LESS THANA1", ENTERA1"
(95) 95+ cigarettes
(97) Refused
(99) Don't know
(2) No
(7) Refused
(9) Don't know
[p. 24]
Part B - Leisure-time physical activity
FR: IF NECESSARY, PROMPT WITH: HOW MANY TIMES PER DAY, PER WEEK, PER MONTH, OR PER YEAR DO YOU DO THESE ACTIVITIES?
(000) Never (AHB.110)
(001-995) 1-995 times
(996) Unable to do this type activity (AHB.110)
(997) Refused (AHB.110)
(999) Don't know (AHB.110)
(0) Never
(1) Day
(2) Week
(3) Month
(4) Year
(6) Unable to do this type activity
(7) Refused
(9) Don't know
AHB.100
(001-995) 1-995
(997) Refused (AHB.110)
(999) Don't know (AHB.108)
(1) Minutes (AHB.110)
(2) Hours (AHB.110)
(7) Refused (AHB.110)
(9) Don't know (AHB.108)
AHB.108
(2) 20 minutes or more
(7) Refused
(9) Don't know
[p. 25]
FR: IF NECESSARY, PROMPT WITH: HOW MANY TIMES PER DAY, PER WEEK, PER MONTH, OR PER YEAR DO YOU DO THESE ACTIVITIES?
(000) Never (AHB.130)
(001-995) 1-995 times
(996) Unable to do this type activity (AHB.130)
(997) Refused (AHB.130)
(999) Don't know (AHB.130)
(0) Never
(1) Day
(2) Week
(3) Month
(4) Year
(6) Unable to do this type activity
(7) Refused
(9) Don't know
AHB.120
(001-995) 1-995
(997) Refused (AHB.130)
(999) Don't know (AHB.128)
(1) Minutes (AHB.130)
(2) Hours (AHB.130)
(7) Refused (AHB.130)
(9) Don't know (AHB.128)
AHB.128
(2) 20 Minutes or more
(7) Refused
(9) Don't know
[p. 26]
FR: IF NECESSARY, PROMPT WITH: HOW MANY TIMES PER DAY, PER WEEK, PER MONTH, OR PER YEAR DO YOU DO THESE ACTIVITIES?
(000) Never
(001-995) 1-995 times
(996) Unable to do this type activity
(997) Refused
(999) Don't know
(0) Never
(1) Day
(2) Week
(3) Month
(4) Year
(6) Unable to do this activity
(7) Refused
(9) Don't know
[p. 27]
PART C - Alcohol
AHB.140
(2) No (AHB.150)
(7) Refused (AHB.150)
(9) Don't know (AHB.150)
(2) No (AHB.190)
(7) Refused (AHB.190)
(9) Don't know (AHB.190)
FR: IF NECESSARY, PROMPT WITH:A HOW MANY DAYS PER WEEK, PER MONTH, OR PER YEAR DID YOU DRINK? @
(000) Never (AHB.190)
(001-365) 1-365 days
(997) Refused (AHB.190)
(999) Don't know (AHB.170)
(0) Never/None (AHB.190)
(1) Week (AHB.170)
(2) Month (AHB.170)
(3) Year (AHB.170)
(7) Refused (AHB.190)
(9) Don't know (AHB.170)
FR: IF LESS THAN 1 DRINK, ENTER A1"
(95) 95+ drinks
(97) Refused
(99) Don't know
[p. 28]
FR: IF NECESSARY, PROMPT WITH: HOW MANY DAYS PER WEEK, PER MONTH, OR PER YEAR DID YOU HAVE 5 OR MORE DRINKS IN A SINGLE DAY?
(000) Never/None (AHB.190)
(001-365) 1-365 days
(997) Refused (AHB.190)
(999) Don't know (AHB.190)
(0) Never/None
(1) Week
(2) Month
(3) Year
(7) Refused
(9) Don't know
(02-07) 2-7 feet
(97) Refused
(99) Don't know
(M) Reported in metric (AHB.195)
AHB.190B
(00-11) 0-11 inches
(97) Refused
(99) Don't know
(Go to AHB.200)
FR: ENTERAM@ TO RECORD METRIC MEASUREMENTS
AHB.195
(0-2) 0-2 meters
(7) Refused
(9) Don't know
(000-241) 0-241 centimeters
(997) Refused
(999) Don't know
[p. 29]
(050-500) 50-500 pounds (Go to next section)
(997) Refused (Go to next section)
(999) Don't know (Go to next section)
(M) Reported in metric (AHB.205)
FR: ENTER "M" TO RECORD METRIC MEASUREMENTS
AHB.205
(0227-2268) 22.7-226.8 kilograms
(9997) Refused
(9999) Don't know
Section V - HEALTH CARE ACCESS AND UTILIZATION
Part A - Access to Care
AAU.020
(2) There is NO place (AAU.037)
(3) There is MORE THAN ONE place (AAU.030)
(7) Refused (AAU.037)
(9) Don't know (AAU.037)
[If AAU.020 equals (3) read:]
What kind of place do you go to most often - a clinic, doctor's office, emergency room, or some other place?
(1) Clinic or health center (AAU.035)
(2) Doctor's office or HMO (AAU.035)
(3) Hospital emergency room (AAU.035)
(4) Hospital outpatient department (AAU.035)
(5) Some other place (AAU.035)
(6) Doesn't go to one place most often (AAU.037)
(7) Refused (AAU.037)
(9) Don't know (AAU.037)
(2) No (AAU.037)
(7) Refused (AAU.037)
(9) Don't know (AAU.037)
(1) Clinic or health center
(2) Doctor's office or HMO
(3) Hospital emergency room
(4) Hospital outpatient department
(5) Some other place
(6) Doesn't go to one place most often
(7) Refused
(9) Don't know
AAU.040 AAU.050
(2) No (AAU.061)
(7) Refused (AAU.061)
(9) Don't know (AAU.061)
(2) No
(7) Refused
(9) Don't know
(1) Yes
(2) No
(7) Refused
(9) Don't know
AHCDLYR2 ...You couldn't get an appointment soon enough.
AHCDLYR3 ...Once you get there, you have to wait too long to see the doctor.
AHCDLYR4 ...The (clinic/doctor's office) wasn't open when you could get there.
AHCDLYR5 ...You didn't have transportation.
(1) Yes
(2) No
(7) Refused
(9) Don't know
AHCAFYR2 ...Mental health care or counseling
AHCAFYR3 ...Dental care (including check-ups)
AHCAFYR4 ...Eyeglasses
[p. 32]
Part B - Dental Care
About how long has it been since you last saw a dentist? Include all types of dentists, such as orthodontists, oral surgeons, and all other dental specialists, as well as dental hygienists.
1. 6 months or less
2. More than 6 months, but not more than 1 year ago
3. More than 1 year, but not more than 2 years ago
4. More than 2 years, but not more than 5 years ago
5. More than 5 years ago
(1) 6 months or less
(2) More than 6 months, but not more than 1 year ago
(3) More than 1 year, but not more than 2 years ago
(4) More than 2 years, but not more than 5 years ago
(5) More than 5 years
(7) Refused
(9) Don't know
[p. 33]
Part C - Health Care Provider Contacts
(1) Yes
(2) No
(7) Refused
(9) Don't know
AHCSYR2 ...An optometrist, ophthalmologist, or eye doctor (someone who prescribes eyeglasses)?
AHCSYR3 ...A foot doctor?
AHCSYR4 ...A chiropractor?
AHCSYR5 ...A physical therapist, speech therapist, respiratory therapist, audiologist, or occupational therapist?
AHCSYR6 ...A nurse practitioner, physician assistant, or midwife?
AAU.200
DURING THE PAST 12 MONTHS, that is since {12 month ref.date}, have you seen or talked to any of the following health care providers about your own health?
...A doctor who specializes in women's health (an obstetrician/gynecologist)?
(2) No
(7) Refused
(9) Don't know
DURING THE PAST 12 MONTHS, that is since {12 month ref.date}, have you seen or talked to any of the following health care providers about your own health?
(2) No
(7) Refused
(9) Don't know
(2) No (AAU.240)
(7) Refused (AAU.240)
(9) Don't know (AAU.240)
AAU.230
(2) No
(7) Refused
(9) Don't know
[p. 32]
DURING THE PAST 12 MONTHS, HOW MANY TIMES have you gone to a HOSPITAL EMERGENCY ROOM about your own health? (This includes emergency room visits that resulted in a hospital admission.)
1. 1
2. 2-3
3. 4-5
4. 6-7
5. 8-9
6. 10-12
7. 13-15
8. 16 or more
(01) 1
(02) 2-3
(03) 4-5
(04) 6-7
(05) 8-9
(06) 10-12
(07) 13-15
(08) 16 or more
(97) Refused
(99) Don't know
(2) No (AAU.280)
(7) Refused (AAU.280)
(9) Don't know (AAU.280)
(97) Refused
(99) Don't know
What was the total number of home visits received during {that month/those months}?
2. 2-3
3. 4-5
4. 6-7
5. 8-9
6. 10 -12
7. 13-15
8. 16 or more
(02) 2-3
(03) 4-5
(04) 6-7
(05) 8-9
(06) 10-12
(07) 13-15
(08) 16 or more
(97) Refused
(99) Don't know
DURING THE PAST 12 MONTHS, HOW MANY TIMES have you seen a doctor or other health care professional about your own health at a DOCTOR'S OFFICE, A CLINIC, OR SOME OTHER
PLACE? DO NOT INCLUDE TIMES YOU WERE HOSPITALIZED OVERNIGHT, VISITS TO HOSPITAL EMERGENCY ROOMS, HOME VISITS, DENTAL VISITS, OR TELEPHONE CALLS.
1. 1
2. 2-3
3. 4-5
4. 6-7
5. 8-9
6. 10-12
7. 13-15
8. 16 or more
(01) 1
(02) 2-3
(03) 4-5
(04) 6-7
(05) 8-9
(06) 10-12
(07) 13-15
(08) 16 or more
(97) Refused
(99) Don't know
[p. 33]
FR:(READ IF NECESSARY) THIS INCLUDES BOTH MAJOR SURGERY AND MINOR PROCEDURES SUCH AS SETTING BONES OR REMOVING GROWTHS.
(2) No (Check item AAUCCI8)
(7) Refused (Check item AAUCCI8)
(9) Don't know (Check item AAUCCI8)
FR: ENTER 95 FOR 95 OR MORE TIMES.
(95) 95+ times
(97) Refused
(99) Don't know
AAU.305
About how long has it been since you last saw or talked to a doctor or other health care professional about your own health? Include doctors seen while a patient in a hospital.
1. 6 months or less
2. More than 6 months, but not more than 1 year ago
3. More than 1 year, but not more than 2 years ago
4. More than 2 years, but not more than 5 years ago
5. More than 5 years ago
(1) 6 months or less
(2) More than 6 months, but not more than 1 year ago
(3) More than 1 year, but not more than 2 years ago
(4) More than 2 years, but not more than 5 years ago
(5) More than 5 years ago
(7) Refused
(9) Don't know
[p. 36]
Part D - IMMUNIZATIONS
(2) No
(7) Refused
(9) Don't know
(2) No
(7) Refused
(9) Don't know
(2) No (AAU.350)
(7) Refused (AAU.350)
(9) Don't know (AAU.350)
(2) No
(7) Refused
(9) Don't know
(2) No (AAU.360)
(7) Refused (AAU.360)
(9) Don't know (AAU.360)
(2) No
(7) Refused
(9) Don't know
FR: READ IF NECESSARY: This is given in three separate doses and has been available since 1991. It is recommended for newborn infants, adolescents, and people such as health care workers, who may be exposed to the hepatitis B virus.
(2) No (end section)
(7) Refused (end section)
(9) Don't know (end section)
AAU.380
(2) Received less than 3 doses
(7) Refused
(9) Don't know
Section VI - DEMOGRAPHICS
ASD.050 ASD.060
Is that correct?
(2) No
(7) Refused
(9) Don't know
If WRKVER eq (2) goto WRKCOR
else if DOINGLW1 eq (1, 2, 4) goto WHOWRK
else if DOINGLW1 eq (3, 5) goto EVERWRK
What is your correct working status?
(2) With a job or business but not at work
(3) Looking for workfor work
(4) Working, but not for pay, at a job or business
(5) Not working at a job or business AND not looking
(7) Refused
(9) Don't know
(1) Working for pay at a job or business
(2) With a job or business but not at work
(3) Looking for work
(4) Working, but not for pay, at a job or business
(5) Not working at a job or business AND not looking for work
(7) Refused
(9) Don't Know
else If DOINGLW1 eq (1, 4) goto WHOWRK
else If DOINGLW1 eq (3) goto EVERWRK
else goto next section
[p. 38]
(02) Going to school
(03) Retired
(04) On a planned vacation from work
(05) On family or maternity leave
(06) Unable to work for health reasons
(07) On layoff
(08) Disabled
(09) Have job/contract;off season
(10) Other
(97) Refused
(99) Don't know
If DOINGLW1 eq (1,2,4) go to WHOWRK; else
If DOINGLW1 eq (3,5) go to EVERWRK
NOTE: At this point, information from WHYNOWRK in FSD and WHYNOWK2 is used to create WHYNOWK1.
(2) No (goto ASD.180.010)
(7) Refused (goto ASD.180.010)
(9) Don't know (goto ASD.180.010)
If EVERWRK eq (1) or DOINGLW1 eq (1, 2, 4) goto WHOWRK; else goto next section.
For whom did you work at your MAIN job or business? (Name of company, business, organization, or employer)
[If (EVERWRK eq (1) and WHYNOWK1 eq (3)) or AGE ge (65)]
Thinking about the job you held the longest, for whom did you work? (Name of company, business, organization, or employer)
[If EVERWRK eq (1) and WHYNOWK1 ne (3) and AGE lt (65)]
Thinking about the job you held most recently, for whom did you work? (Name of company, business, organization, or employer)
(7) Refused
(9) Don't know
(7) Refused
(9) Don't know
[p. 39]
(7) Refused
(9) Don't know
(7) Refused
(9) Don't know
[If DOINGLW1 eq (1,2,4)]
Looking at the card, which of these best describes your current job or work situation?
[If (EVERWRK eq (1) and WHYNOWK1 eq (3)) or AGE ge (65)]
Looking at the card, which of these best describes the job you held for the longest time?
[If EVERWRK eq (1) and WHYNOWK1 ne (3) and AGE lt (65)]
Looking at the card, which of these best describes the job you held most recently?
FR: READ IF NECESSARY
2. A FEDERAL government employee
3. A STATE government employee
4. A LOCAL government employee
5. Self-employed in OWN business, professional practice or farm
6. Working WITHOUT PAY in family business or farm
(2) A FEDERAL government employee
(3) A STATE government employee
(4) A LOCAL government employee
(5) Self-employed in OWN business, professional practice or farm
(6) Working WITHOUT PAY in family business or farm
(7) Refused
(9) Don't know
If WRKCAT eq (1, 2, 3, 4, 6, 7,9) go to LOCALL1; else If WRKCAT eq (5) goto BUSINC1
(2) No
(7) Refused
(9) Don't know
[p. 40]
[If DOINGLW1 eq (1,2,4)]
Thinking about this MAIN job or business,
[If (EVERWRK eq (1) and WHYNOWK1 eq (3)) or AGE ge (65)]
Thinking about your last week at the job you held the longest,
[If EVERWRK eq (1) and WHYNOWK1 ne (3) and AGE lt (65)]
Thinking about your last week at the job you held most recently, how many people work(ed) at this location?
NOTE TO FR: "People" includes both full- and part-time employees; "location" refers to the street address of the workplace.
2. 10-24 employees
3. 25-49 employees
4. 50-99 employees
5. 100-249 employees
6. 250-499 employees
7. 500-999 employees
8. 1000 employees or more
(2) 10-24 employees
(3) 25-49 employees
(4) 50-99 employees
(5) 100-249 employees
(6) 250-499 employees
(7) 500-999 employees
(8) 1000 employees or more
(7) Refused
(9) Don't know
About how long have you worked at this MAIN job or business?
[If (EVERWRK eq (1) and WHYNOWK1 eq (3)) or AGE ge (65)]
About how long did you work at the job you held the longest?
[If EVERWRK eq (1) and WHYNOWK1 ne (3) and AGE lt (65)]
About how long did you work at the job you held most recently?
(001-365) 1-365
(997) Refused
(999) Don't know
If WRKLONG1 eq (997, 999) goto HOURPD;
else if WRKLONG1 eq (001-365) goto WRKLONG2
(1) Day(s)
(2) Week(s)
(3) Month(s)
(4) Year(s)
(7) Refused
(9) Don't Know
[p. 41]
(2) Proceed
Is this main job or business the job you have held for the longest?
[If (EVERWRK eq (1) and WHYNOWK1 eq (3)) or AGE lt (65)]
Was your most recently held job also the job you held the longest?
(2) No
(7) Refused
(9) Don't know
Are you paid by the hour at this MAIN job or business?
[If (EVERWRK eq (1) and WHYNOWK1 eq (3)) or AGE ge (65)]
Were you paid by the hour on this job you held the longest?
[If EVERWRK eq (1) and WHYNOWK1 ne (3) and AGE lt (65)]
Were you paid by the hour on this job you held most recently?
(2) No
(7) Refused
(9) Don't know
Do you have paid sick leave on this MAIN job or business?
[If (EVERWRK eq (1) and WHYNOWK1 eq (3)) or AGE ge (65)]
Did you ever have paid sick leave on this job you held the longest?
[If EVERWRK eq (1) and WHYNOWK1 ne (3) and AGE lt (65)]
Did you ever have paid sick leave on this job you held most recently?
(2) No
(7) Refused
(9) Don't know
(2) No
(7) Refused
(9) Don't know
[p. 42]
ASD.180.010
(2) No (goto A_DEMO_END)
(7) Refused ( goto A_DEMO_END)
(8) Don't know (ASD.180.020)
(2) No
(7) Refused
(9) Don't know
Section VII - AIDS
Have you donated blood since March 1985?
(2) No (ADS.040)
(7) Refused (ADS.040)
(9) Don't know (ADS.040)
(2) No
(7) Refused
(9) Don't know
If ADS.010 equals (1) read:
Except for tests you may have had as part of blood donations, have you ever been tested for HIV?
Else read:
Have you ever been tested for HIV?
(2) No (ADS.050)
(7) Refused (ADS.110)
(9) Don't know (ADS.110)
I am going to show you a list of reasons why some people have not been tested for HIV, (the virus that causes AIDS). Which one of these would you say is the MAIN reason why you have not been tested?
2. You were afraid to find out if you were HIV positive (that you had HIV)
3. You didn't want to think about HIV or about being HIV positive
4. You were worried your name would be reported to the government if you tested positive
5. You didn't know where to get tested
6. You don't like needles
7. You were afraid of losing job, insurance, housing, friends, family, if people knew you were positive for AIDS infection
8. Some other reason
9. No particular reason
(02) You were afraid to find out if you were HIV positive (that you had HIV); (ADS.110)
(03) You didn't want to think about HIV or about being HIV positive; (ADS.110)
(04) You were worried your name would be reported to the government if you tested positive; (ADS.110)
(05) You didn't know where to get tested; (ADS.110)
(06) You Don't like needles; (ADS.110)
(07) You were afraid of losing job, insurance, housing, friends, family, if people knew you were positive for AIDS infection; (ADS.110)
(08) Some other reason; (ADS.055)
(09) No particular reason; (ADS.110)
(97) Refused; (ADS.110)
(99) Don't Know; (ADS.110)
ADS.055
[p. 44]
Not including blood donations, in what month and year was your last test for HIV, (the virus that causes AIDS)?
Else read:
In what month and year was your last test for HIV, (the virus that causes AIDS)?
FR: Enter T for Time Period (ADS.061)
(01) January
(02) February
(03) March
(04) April
(05) May
(06) June
(07) July
(08) August
(09) September
(10) October
(11) November
(12) December
(97) Refused (ADS.061)
(99) Don't know
(1880-2030) 1880-2030 (ADS.065)
(97) Refused (ADS.061)
(99) Don't know (ADS.061)
ADS.061
(2) More than 6 months but not more than 1 year ago
(3) More than 1 year, but not more than 2 years ago
(4) More than 2 years, but not more than 5 years ago
(5) More than 5 years ago
(7) Refused
(9) Don't know
___ times
(97) Refused
(99) Don't know
[p. 45]
I am going to show you a list of reasons why some people have been tested for HIV, (the virus that causes AIDS).
If ADS.020 equals (1) read:
Not including your blood donations, which of these would you say was the MAIN reason for your last HIV test?
Else read:
Which of these would you say was the MAIN reason for your last HIV test?
2. You might have been exposed through sex or drug use
3. You might have been exposed through your work or at work
4. You just wanted to find out if you were infected or not
5. For part of a routine medical check-up, or for hospitalization or surgical procedure
6. You were sick or had a medical problem
7. You were pregnant or delivered a baby
8. For health or life insurance coverage
9. For military induction, separation, or military service
10. For immigration
11. For marriage license or to get married
12. You were concerned you could give HIV to someone
13. You wanted medical care or new treatments if you tested positive
14. Some other reason
15. No particular reason
(02) You might have been exposed through sex or drug use; (ADS.070)
(03) You might have been exposed through your work or at work; (ADS.070)
(04) You just wanted to find out if you were infected or not; (ADS.070)
(05) For part of a routine medical check-up, or for hospitalization or surgical procedure; (ADS.070)
(06) You were sick or had a medical problem; (ADS.070)
(07) You were pregnant or delivered a baby; (ADS.070)
(08) For health or life insurance coverage; (ADS.070)
(09) For military induction, separation, or military service; (ADS.070)
(10) For immigration; (ADS.070)
(11) For marriage license or to get married; (ADS.070)
(12) You were concerned you could give HIV to someone; (ADS.070)
(13) You wanted medical care or new treatments if you tested positive; (ADS.070)
(14) Some other reason. (ADS.069)
(15) No particular reasons. (ADS.070)
(97) Refused(ADS.070)
(99) Don't know (ADS.070)
(2) Sex partner (ADS.070)
(3) Someone at health department (ADS.070)
(4) Family member or friend (ADS.070)
(5) Other (ADS.067)
(7) Refused (ADS.070)
(9) Don't know (ADS.070)
ADS.067
[p. 46]
If ADS.010 equals (1) read:
Not including your blood donations, where did you have your last HIV test?
Else read:
Where did you have your last HIV test?
2. AIDS clinic/counseling/testing site
3. Hospital, emergency room, outpatient clinic
4. Other type of clinic
5. Public health department
6. At home
7. Drug treatment facility
8. Military induction or military service site
9. Immigration site
10. In a correctional facility (jail or prison)
11. Other location
(02) AIDS clinic/counseling/testing site (ADS.080)
(03) Hospital, emergency room, outpatient clinic (ADS.080)
(04) Other type of clinic (ADS.072)
(05) Public health department (ADS.080)
(06) At home (ADS.074)
(07) Drug treatment facility (ADS.080)
(08) Military induction or military service site (ADS.080)
(09) Immigration site (ADS.080)
(10) In a correctional facility (jail or prison) (ADS.080)
(11) Other location (ADS.076)
(97) Refused (ADS.080)
(99) Don't know/not sure (ADS.080)
(02) Prenatal clinic
(03) Tuberculosis clinic
(04) STD clinic
(05) Community health clinic
(06) Clinic run by employer or insurance company
(07) Other
(97) Refused
(99) Don't know
ADS.074
(2) Self-sampling kit
(7) Refused
(9) Don't know
ADS.076
FR: THIS SHOULD BE A SPECIFIC LOCATION THAT IS NOT ON THE LIST.
[p. 47]
(2) No
(7) Refused
(9) Don't know
Do you expect to have another test for HIV in the next 12 months, not including blood donations?
Else, read:
Do you expect to have a test for HIV in the next 12 months, not including blood donations?
(2) No
(7) Refused
(9) Don't know
(2) Medium
(3) Low
(4) None
(5) Already have HIV or AIDS
(7) Refused
(9) Don't know
Tell me if ANY of these statements is true for YOU. Do NOT tell me WHICH statement or statements are true for you. Just IF ANY of them are.
(a) You have hemo philia and have received clotting factor concentrations.
(b) You are a man who has had sex with other men, even just one time.
(c) You have taken street drugs by needle, even just one time.
(d) You have traded sex for money or drugs, even just one time.
(e) You have tested positive for HIV, (the virus that causes AIDS).
(f) You have had sex (even just one time) with someone who would answerAyes@ to any of these statements
b. You are a man who has had sex with other men, even just one time
c. You have taken street drugs by needle, even just one time
d. You have traded sex for money or drugs, even just one time
e. You have tested positive for HIV, the virus that causes AIDS
f. You have had sex (even just one time) with someone who would answer "yes" to any of these statements
(2) No, none of these statements are true
(7) Refused
(9) Don't know
ADS.160
In the past five years, have you had an STD other than HIV or AIDS?
FR: IF ASKED, TELL RESPONDENT TO INCLUDE NEWLY CONTRACTED STDs AND RECURRING FLARE-UPS OF PREVIOUSLY CONTRACTED STDs.
(2) No(ADS.200)
(7) Refused (ADS.200)
(9) Don't Know (ADS.200)
[p. 48]
(2) No (ADS.200)
(7) Refused (ADS.200)
(9) Don't Know (ADS.200)
FR: READ ANSWER CHOICES ONLY IF NECESSARY.
(2) Family planning clinic (ADS.200)
(3) STD clinic (ADS.200)
(4) Emergency room (ADS.200)
(5) Health department (ADS.200)
(6) Some other place (ADS.190)
(7) Refused (ADS.200)
(9) Don't Know (ADS.200)
ADS.190
Have you ever heard of tuberculosis?
(2) No (ADS.260)
(7) Refused (ADS.260)
(9) Don't Know (ADS.260)
(2) No
(7) Refused
(9) Don't Know
(2) Some (ADS.230)
(3) A little (ADS.230)
(4) Nothing (ADS.250)
(7) Refused (ADS.260)
(9) Don't know (ADS.260)
FR: SHOW FLASHCARD A14. MARK ALL THAT APPLY. ENTER (N) FOR NO MORE.
You may choose more than one
2. Sharing eating/drinking utensils
3. Through semen or vaginal secretions shared during sexual intercourse
4. From smoking
5. From mosquito or other insect bites
6. Other
(2) Sharing eating / drinking utensils
(3) Through semen or vaginal secretions shared during sexual intercourse
(4) From smoking
(5) From mosquito or other insect bites
(6) Other
(7) Refused
(9) Don't know
[p. 49]
(2) No
(7) Refused
(9) Don't Know
(2) Medium
(3) Low
(4) None
(5) Already have TB
(7) Refused
(9) Don't Know
If a member of your family were diagnosed with TB, would you feel ashamed or embarrassed?
Else, read:
If you or a member of your family were diagnosed with TB, would you feel ashamed or embarrassed?
(2) No
(7) Refused
(9) Don't Know
(2) No
(7) Refused
(9) Don't know
[p. 88]
Section IX - DIS
Do you NOW use any special equipment or assistive devices to aid you in your usual activities?
(2) No
(7) Refused
(9) Don't know
(2) No (DIS_INTRO)
(7) Refused (DIS_INTRO)
(9) Don't know (DIS_INTRO)
(2) Often
(3) Sometimes
(4) Rarely
(5) Never
(7) Refused
(9) Don't know
possible barriers that might limit or prevent your activities.
FR: SHOW FLASHCARD A20
By barriers we mean things such as building design, lighting, sound, household or workplace
equipment, crowds, sidewalks and curbs, transportation, attitudes of other people, and policies.
You may choose more than one
2. Lighting (too dim to read, signs not lit, too bright, too distracting)
3. Sound (background noise, inadequate sound system)
4. Household or workplace equipment hard to use
5. Crowds
6. Sidewalks and curbs
7. Transportation
8. Attitudes of other people
9. Policies (rental policies, eligibility for services, workplace rules)
10. Other barriers
(Goto DISHOME)
DIS.040
FR: SHOW FLASHCARD A20
You may choose more than one
2. Lighting (too dim to read, signs not lit, too bright, too distracting)
3. Sound (background noise, inadequate sound system)
4. Household or workplace equipment hard to use
5. Crowds
6. Sidewalks and curbs
7. Transportation
8. Attitudes of other people
9. Policies (rental policies, eligibility for services, workplace rules)
10. Other barriers
(2) No (DIS.070)
(7) Refused (DIS.070)
(9) Don't know (DIS.070)
[p. 89]
FR: SHOW FLASHCARD A20. MARK ALL THAT APPLY. ENTER (N) FOR NO MORE.
You may choose more than one
2. Lighting (too dim to read, signs not lit, too bright, too distracting)
3. Sound (background noise, inadequate sound system)
4. Household or workplace equipment hard to use
5. Crowds
6. Sidewalks and curbs
7. Transportation
8. Attitudes of other people
9. Policies (rental policies, eligibility for services, workplace rules)
10. Other barriers
DIHM02 Lighting (too dim to read, signs not lit, too bright, too distracting)
DIHM03 Sound (background noise, inadequate sound system)
DIHM04 Household or workplace equipment hard to use
DIHM05 Crowd
DIHM06 Sidewalks and curbs
DIHM07 Transportation
DIHM08 Attitudes of other people
DIHM09 Policies (rental policies, eligibility for services, workplace rules)
DIHM10 Other barriers
(9) Don't know
If DIHM = (97) or (99) or DIHM_B = () go to DISSCH, ELSE go to DIHM_12.
Enter (B) to backup
(Goto DIHM)
Enter (B) to backup
(Goto DIHM)
(2) Often
(3) Sometimes
(4) Rarely
(7) Refused
(9) Don't know
(2) No (DIS.100)
(3) Do not attend school/training for other reasons (DIS.100)
(7) Refused (DIS.100)
(9) Don't know (DIS.100)
FR: SHOW FLASHCARD A20. MARK ALL THAT APPLY. ENTER (N) FOR NO MORE.
You may choose more than one
2. Lighting (too dim to read, signs not lit, too bright, too distracting)
3. Sound (background noise, inadequate sound system)
4. Household or workplace equipment hard to use
5. Crowds
6. Sidewalks and curbs
7. Transportation
8. Attitudes of other people
9. Policies (rental policies, eligibility for services, workplace rules)
10. Other barriers
DISC02 Lighting (too dim to read, signs not lit, too bright, too distracting)
DISC03 Sound (background noise, inadequate sound system)
DISC04 Household or workplace equipment hard to use
DISC05 Crowds
DISC06 Sidewalks and curbs
DISC07 Transportation
DISC08 Attitudes of other people
DISC09 Policies (rental policies, eligibility for services, workplace rules)
DISC10 Other barriers
(9) Don't know
If DISC = (97) or (99) or DISC_B = () go to DISWRK, ELSE go to DISC_12.
Enter (B) to backup
(Goto DISC)
Enter (B) to backup
(Goto DISC)
[p. 91]
(2) Often
(3) Sometimes
(4) Rarely
(7) Refused
(9) Don't know
DIS.100
FR: SHOW FLASHCARD A20
You may choose more than one
2. Lighting (too dim to read, signs not lit, too bright, too distracting)
3. Sound (background noise, inadequate sound system)
4. Household or workplace equipment hard to use
5. Crowds
6. Sidewalks and curbs
7. Transportation
8. Attitudes of other people
9. Policies (rental policies, eligibility for services, workplace rules)
10. Other barriers
(2) No (DIS.130)
(3) Do not work for other reasons (DIS.130)
(7) Refused (DIS.130)
(9) Don't know (DIS.130)
FR: SHOW FLASHCARD A20. MARK ALL THAT APPLY. ENTER (N) FOR NO MORE.
You may choose more than one
2. Lighting (too dim to read, signs not lit, too bright, too distracting)
3. Sound (background noise, inadequate sound system)
4. Household or workplace equipment hard to use
5. Crowds
6. Sidewalks and curbs
7. Transportation
8. Attitudes of other people
9. Policies (rental policies, eligibility for services, workplace rules)
10. Other barriers
DIWK02 Lighting (too dim to read, signs not lit, too bright, too distracting)
DIWK03 Sound (background noise, inadequate sound system)
DIWK04 Household or workplace equipment hard to use
DIWK05 Crowds
DIWK06 Sidewalks and curbs
DIWK07 Transportation
DIWK08 Attitudes of other people
DIWK09 Policies (rental policies, eligibility for services, workplace rules)
DIWK10 Other barriers
(9) Don't know
If DIWK = (97) or (99) or DIWK_B = () go to DISCA, ELSE go to DIWK_12.
Enter (B) to backup
(Goto DISC)
[p. 92]
Enter (B) to backup
(Goto DIWK)
(2) Often
(3) Sometimes
(4) Rarely
(7) Refused
(9) Don't know
DIS.130
FR: SHOW FLASHCARD A20
You may choose more than one
2. Lighting (too dim to read, signs not lit, too bright, too distracting)
3. Sound (background noise, inadequate sound system)
4. Household or workplace equipment hard to use
5. Crowds
6. Sidewalks and curbs
7. Transportation
8. Attitudes of other people
9. Policies (rental policies, eligibility for services, workplace rules)
10. Other barriers
(2) No (DIS.160)
(7) Refused (DIS.160)
(9) Don't know (DIS.160)
FR: SHOW FLASHCARD A20. MARK ALL THAT APPLY. ENTER (N) FOR NO MORE.
You may choose more than one
2. Lighting (too dim to read, signs not lit, too bright, too distracting)
3. Sound (background noise, inadequate sound system)
4. Household or workplace equipment hard to use
5. Crowds
6. Sidewalks and curbs
7. Transportation
8. Attitudes of other people
9. Policies (rental policies, eligibility for services, workplace rules)
10. Other barriers
DICA02 Lighting (too dim to read, signs not lit, too bright, too distracting)
DICA03 Sound (background noise, inadequate sound system)
DICA04 Household or workplace equipment hard to use
DICA05 Crowds
DICA06 Sidewalks and curbs
DICA07 Transportation
DICA08 Attitudes of other people
DICA09 Policies (rental policies, eligibility for services, workplace rules)
DICA10 Other barriers
(9) Don't know
If DICA = (97) or (99) or DICA_B = () go to DISHFAC, ELSE go to DICA_12.
Enter (B) to backup
(Goto DICA)
Enter (B) to backup
(Goto DICA)
(2) Often
(3) Sometimes
(4) Rarely
(7) Refused
(9) Don't know
DIS.160
Do you NOW have ACCESS to a health club, wellness program or fitness facility that meets your needs, if you wanted to use one?
(2) No (DIS.170)
(7) Refused (DIS.180)
(9) Don't know (DIS.180)
FR: SHOW FLASHCARD A21. MARK ALL THAT APPLY. ENTER (N) FOR NO MORE.
You may choose more than one
2. Lack of transportation
3. Access intolwithin the building
4. Lack of exercise equipment that meets your needs
5. Lack of an instructor to show you how to use the equipment
6. Other
DISHFL02 Cost is too high for your budget
DISHFL03 Lack of transportation
DISHFL04 Access into/within the building
DISHFL05 Lack of exercise equipment that meets your needs
DISHFL06 Lack of an instructor to show you how to use the equipment
DISHFL07 Other
(9) Don't know
Which ones? (PROBE: Any others?)
ELSE goto DISHFUSE.
If DISHFLIM = (7) or (9) or DISHFLIM_B = () go to DISHFUSE,
ELSE go to DISHFLIM_12.
Enter (B) to backup
(Goto DISHFLIM)
"Don't know and/or Refused" response not permitted with other answers
Enter (B) to backup
(Goto DISHFLIM)
"Zero (0)" response not permitted with other answers
Enter (B) to backup
(Goto DISHFLIM)
DIS.180
(2) No
(7) Refused
(9) Don't know
(goto next section)